MEDICARE: ACHAIA LOGAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174H00000X	Health Educator		MD

General Provider Information

NPI Number	:	1114779162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ACHAIA LOGAN

Provider Business Mailing Address
First Line	:	4390 PARLIAMENT PL STE A
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20706-1866
Country	:	US
Telephone Number	:	443-962-3695
Fax Number	:

Provider Business Practice Location Address
First Line	:	4390 PARLIAMENT PL STE A
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20706-1866
Country	:	US
Telephone Number	:	443-962-3695
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2024
Last Update Date	:	04/03/2024

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Directions to “ ACHAIA LOGAN ” Practice Location

Language	Start Address	Practice Location

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